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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 33499
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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My question regards XXXXX XXXXX day. I have been to er

Customer Question

My question regards XXXXX XXXXX day. I have been to er room. Was given predisone and robaxin. Went 2 days to er. Sent me to neurology clinic and Dr totally infuriated me. Said it was not med problem but a me problem. Said the pain Meds on is causing migraines. Have been on them for over 7-8 yrs. And to tell me to stop immediately just angered me. He does not know my history or pain level. He was very rude and uncaring. And said my drinking tea and diet coke which are both caffiene free. He prescribed topamax which takes over month to get in system, but offered no other suggestions for immediate relief. I was not asking for pain meds just migraine Meds. My primary care physician gave me fiorocet. Which I told her was not working. Now I did have heart attack in 2011, and have 4!stents. Just cannot believe there is nothing I can take for relief until topamax takes affect. I am absolutely miserable. Any help would be appreciated.
Submitted: 4 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 4 years ago.

Greetings Kimberly.

I can understand your disappointment with the visit to Neurologist. I am sorry about it.

Since when do you have migraine attacks?
What are your pain medications?

Dr. Arun

Customer: replied 4 years ago.
Oxycodone3/325 4 daily and tramadol 50 mg 4 daily. And I do take Meds as I'm supposed to. Tested everyttime I see pain specialist. Just called cardiologist. Triptan are not recommended. Do u think some sort of muscle relaxer other than flexerill will work? I have been up all night and still no relief. What is difference between fiorocet and fourinal?
Expert:  Dr. Arun Phophalia replied 4 years ago.

Greetings Kimberly.

Fioricet is brand names of a combination of butalbital (a barbiturate, 50 mg), acetaminophen (325 mg) and caffeine (40 mg) . Epinastine is an ingredient of Flurinol. So both of these are different. The muscle relaxant is not likely to work.

There are two types of medications used for the treatment of migraine;


1) To abort the attack


Dopamine antagonists




2) To prevent the headache


Valproic acid, gabapentin

Calcium channel blockers

Beta-blockers, tricyclic antidepressants


There are dietary triggers known which should be avoided. Common triggers are

a) chocolate,

b) aged cheeses and meats,

c) wine and beer

d) citrus fruits.


Following work up, if not yet done would be advised;

1) visual field testing;
2) erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
3) MRI with Gadolinium contrast
4) Magnetic resonance angiography (MRA)

Meanwhile you may also try following with your present medications for migraine;

1) Biofeedback,
2) cognitive-behavioral therapy
3) relaxation therapy
4) Occipital nerve stimulators
5) herb Butterbur (Petasites hybridus)
6) herb, feverfew,
7) Riboflavin (vitamin B2), used in higher doses (200-400 mg) for 3-4 months,
8) Acupuncture
9) Acupressure


Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.


We have recently implemented a new rating and feedback system. Please be aware that you are rating my courtesy and service as a professional. If you have any questions whatsoever, or there is anything I can clarify for you, please temporarily bypass the rating system by clicking “Continue the Conversation” or "Reply."

Clicking either of the lowest two options reflects poorly on me so please reply to me if there is anything else I can do to help before choosing those options. I appreciate your patience while we work out the kinks. It's important to me that you are 100% satisfied with the service I have provided you. Thank you.

Customer: replied 4 years ago.
So you cannot prescribe anything for me?
Expert:  Dr. Arun Phophalia replied 4 years ago.
Hello Kimberly,

Unfortunately we cannot prescribe here. This is a question answer site. Doctors cannot prescribe online as it is not legal. A personal office visit is required and physical examination is necessary to issue a script. Canadian and Asian online pharmacies can send the medications but these can be substandard and regulatory authorities can stop them.

I understand that this may not be the answer you are looking for. Your physician would be the best to help you. But it would be unfair to you and unprofessional of me were I to provide you with anything less than truthful and honest information. I hope you understand.

You may try these web sites which claims to provide prescription medications;


Although I would like to help, unfortunately, in the United States, it is illegal to write a prescription for any medication for a patient you have not seen in person, and obtained a complete medical history for, and examined. Violating this federal law can result in the loss of the license to practice as well as criminal charges.

Customer: replied 4 years ago.
Don't believe I should have to pay full amount. I was told a Rx would b given to me. Site is very misleading. I am in no better position than I was last night.
Expert:  Dr. Arun Phophalia replied 4 years ago.
I am informing the site administration.